EUS-guided vascular therapy: an effective approach for refractory and per-endoscopic non-variceal gastrointestinal bleeding

Endoscopic ultrasound (EUS) offers transparietal access to vascular structures, enabling localized treatment. Few studies have been published about EUS-guided vascular therapy, with a limited number of patients, especially in non-variceal bleeding. We present our results in this setting.

The primary objective was to evaluate the efficacy of EUS-guided vascular embolization, defined as the disappearance of both Doppler signal and bleeding. Secondary objectives were to document adverse events (AGREE classification), the rate of recurrences, and their management.

This was a single-center retrospective observational study.

All patients included underwent EUS-guided vascular embolization for spontaneous or intraoperative non-variceal GI bleeding, using acrylic bioglue with Lipiodol as embolizing agent.

A total of 42 patients, aged between 31 and 88 years, were included (median 67.5). The origin of the bleeding was spontaneous on a pre-existing lesion in 59.5% of cases, and consecutive to an endoscopic procedure in 40.5% of cases. Initial technical and clinical success rates were 100%. No major adverse event was observed. Seven patients (16.7%) experienced a bleeding recurrence, with a median delay of 42 days [2-127], all in the spontaneous group. Five were managed by a second EUS-guided embolization, and one had a third recurrence managed surgically.

This study underlines the major value of EUS-guided vascular approach in the treatment of recurrent and complex, as well as intraoperative GI bleedings, showing a high efficacy rate and good safety profile. Improvements in embolization techniques and devices would further democratize the procedure.